Risk Factors for Dermatologic Complications
Because of the high incidence of peristomal skin conditions in the ostomy patient population, it is also important to consider certain risk factors that may predispose the patient to developing these complications. If certain risk factors are determined to be positively correlated with peristomal dermatitis, then preventive vigilance can prevail and action can be taken. The previously mentioned case-control study conducted by Nybaek and colleagues in 2009 involved the examination of 199 ostomy patients. The types of ostomies involved were ileostomies, urostomies, and colostomies. One of the main findings was the presence of a relationship between the type of ostomy procedure and the frequency of skin complications: ileostomy patients displayed more peristomal skin problems than urostomy patients, followed by colostomy patients. Of the 82 ileostomy patients, 56% had skin problems, whereas 47% of the 19 urostomy patients and 35% of the 100 colostomy patients had skin problems. Another independent risk factor determined by the authors was the amount of leakage around the stoma. Leakage and resultant skin erosion caused both physical and psychosocial problems for the patients. Finally, patients with a body mass index greater than 30 displayed a positive correlation for developing dermatologic issues around the stoma site. Although tobacco smoking and herniation were mentioned as potential risk factors, no conclusive results from the study validated these possibilities. Eczema and atopic dermatitis were not discussed as possible risk factors for the development of peristomal dermatoses.
Another study conducted in 2006 by Herlufsen and colleagues also had similar results. A total of 202 patients were given questionnaires and clinical examinations. Peristomal dermatoses were found in 57% of the patients with ileostomies, 48% of those with urostomies, and 35% of those with colostomies. The four main skin disorders or problems that were identified were feces-induced erosions, maceration, erythema, and contact dermatitis; these accounted for 77% of all diagnoses, and the disorders were all caused by peristomal leakage of feces or urine.
A study conducted by Hellman and Lago found a trend suggesting that increasing age may also be a risk factor for developing peristomal skin irritations. Ninety-three ostomy patients participated; as in previously mentioned studies, most skin problems were found in ileostomy patients rather than in colostomy patients. The majority of skin problems were found in the age group of 30 to 59 years. Although the results for the age groupings were not statistically significant, a trend was noticed. The authors noted that previous literature suggested that increasing age results in thinner layers of keratin, a thinner epidermis, and less perspiration. This ultimately results in an increased likelihood of sensitivity to occlusive material, solvents, and abrasion.
McNamara and Farber conducted a study involving 597 patients who had undergone ileostomies. In most cases, the dermatitis occurred in areas directly surrounding the ileac stump. This area is often left uncovered because the stoma must be given some room to move without causing any damage. The amount of skin exposed depends on the size of the stump and the size of the opening of the equipment. Loosening of the appliance and the resultant fluid that seeped out from the stoma were the most common causes of irritation. Causes of loose equipment included defects in the abdominal wall, warm weather, sickness (diarrhea), perspiration, and diet that causes loose stools.
Dermatitis. 2010;21(3):138-147. © 2010 American Contact Dermatitis Society
Cite this: Stoma Dermatitis: Prevalent but Often Overlooked - Medscape - Jun 01, 2010.